Transforming and Supporting Patient Care - Health Professions ...

114Chapter 5 – Scope of Practice of Medical Laboratory TechnologyHealth System ChangesIn recent decades, dramatic changes have occurred in the organization,number and type of tests, and role of medical laboratories in health care. Thesechanges affect the role of laboratory professionals to require greater analyticalaccuracy and more stringent test selection and interpretation of results. 40Trends in the practice of patient identification and specimen collectioninclude: 41 automated systems that integrate bar-coding of patientidentification wristbands with proper specimen collection procedure;computerized physician order entry; standardization of specimen collectionprocedures within each health care organization; certification ofphlebotomists; continued migration from glass to plastic blood tubes; andincreased use of blood collection devices that have self-sheathing needlesor no needles at all for patients with indwelling catheters or lines.Patient Safety and Risk of Harm: Laboratory ErrorThe quality of results provided by the laboratory is dependent on thecontrol of pre-analytical factors such as specimen collection, specimenhandling/processing, and specimen integrity. 42Overall, communication between physicians and MLTs on the pre-analyticalphase and the implementation of educational programs for defining criteriaand procedures needs to be improved. Better education of healthprofessionals is seen as a critical contributor for ultimately improvingpatient care and outcomes. 43Four institutional factors were significantly associated with higher overalllaboratory error rates: 44 orders verbally communicated to the laboratory;no policy requiring laboratory staff to compare a printout or display ofordered tests with the laboratory requisitions to confirm that orders hadbeen entered correctly; failure to monitor the accuracy of outpatient orderentry on a regular basis; and a higher percentage of occupied beds (abusier hospital, for example).Most laboratory errors occur in the pre- or post-analytical phases, while aminority (13 to 32 percent) occurs in the analytical portion. Evidencesuggests that quality programs developed around the analytical phase ofthe total testing process would only produce limited improvements, sincethe large majority of errors encountered in clinical laboratories still prevailwithin “extra-analytical” areas of testing. 4540See, for example Plebani, M. Charting the Course of Medical Laboratories in a ChangingEnvironment. Clinica Chemica Acta. Vol 319. 87-100. 2002.41Astion, Michael. Future Trends in Patient Identification & Specimen Collection: Automation andStandardization. Laboratory Errors and Patient Safety. Vol 1: 2. 2004.42Ajeneye, Francis. Pre-Analytical Quality Assurance: A Biomedical Perspective. The BiomedicalScientist. February 2007.43Pansini, N. et al. Total Testing Process: Appropriateness in Laboratory Medicine. Clinica ChemicaActa. Vol 333. 141-145. 2003.44Valenstein, P. and Meier, F. Outpatient Order Accuracy. A College of American Pathologists Q-Probes Study of Requisition Order Entry Accuracy in 660 Institutions. Archives of Pathology andLaboratory Medicine. Vol 123. 1145-1150. 1999.45Lippi, G. et al. Recommendations for Detection and Management of Unsuitable Samples in ClinicalLaboratories. Clinical Chemistry Laboratory Medicine. Vol 45:6. 728-736. 2007.HPRAC Critical Links January 2009